Objectives/Hypothesis The free flap reconstructive protocols of the jaws have been refined over the years and presently are based on bone‐driven approaches that generally use the lower border of the mandible or the anterior surface of the maxilla as the templates for reconstruction because these contours are deemed important to the eventual cosmetic outcomes of patients. The ultimate goal of functional jaw reconstruction, however, is the reconstruction of the dental occlusion and oral rehabilitation. The purpose of the present study was to evaluate the Alberta reconstructive technique (ART), which is a new approach of occlusion‐driven jaw reconstruction with digitally planned immediate osseointegrated implant installation. Study Design Prospective cohort study. Methods This research study considers the ART's safety, effectiveness, accuracy, timeliness of reconstruction, aesthetic appeal, and cost‐effectiveness in comparison with the standard bone‐driven and delayed osseointegrated implant installation (BDD) protocol. Results The ART procedures were as safe and more effective at achieving full occlusal reconstruction and oral rehabilitation. The ART cohort of patients achieved oral rehabilitation in 21.4 month as compared to 73.1 months for the BDD cohort. There were no differences in the aesthetic appeal the two groups. The ART cost an average of $22,004 less than BDD and we calculated the quality adjusted life years gain to be between 2.14 and 4.04 in favour of ART. Conclusions The ART is a good option for patients with jaw defects. It provides a safe, effective, accurate, aesthetic, and cost‐effective reconstruction that restores form and function in a timely manner. Level of Evidence 2b Laryngoscope, 129:S1–S14, 2019

Quantomo is a computer-assisted methodology that is more reliable for quantifying intracerebral haemorrhage volume as compared with the ABC/2 method.

Key Points Question What is the association of clinician sex, use of the electronic health record (EHR), and work culture with clinician burnout? Findings This cross-sectional study of 1310 clinicians found burnout to be more prevalent in women, attending physicians, and advanced practice providers. Multivariate modeling of burnout identified local work culture accounting for 17.6% variance compared with only 1.3% variance for EHR metrics. Female sex independently contributed more to likelihood of clinician burnout and significantly interacted with work culture domains of commitment and work-life balance. Meaning These findings suggest that clinician sex and local work culture may contribute more to burnout than the EHR.

BackgroundIn recent decades, the incidence of oropharyngeal squamous cell carcinoma (OPSCC) has been rising worldwide as a result of increasing oncogenic human papillomavirus (HPV) infections in the oropharynx. EZH2 is an epigenetic regulatory protein associated with tumor aggressiveness and negative survival outcomes in several human cancers. We aimed to determine the role of EZH2 as a potential therapeutic epigenetic target in HPV-positive and negative OPSCC.MethodsThe expression of EZH2 was measured by immunohistochemistry (IHC) and droplet digital PCR (ddPCR) in 2 HPV-positive and 2 HPV-negative cell lines. The cell lines were then cultured and treated with one of 3 EZH2 epigenetic inhibitors (3-deazaneplanocin A, GSK-343 and EPZ005687) or DMSO (control). Following 2, 4 and 7 days of treatment, cells were analyzed and compared by gene expression, cell survival and proliferation assays.ResultsEZH2 targeting resulted in greater inhibition of growth and survival in HPV-positive compared to HPV-negative cells lines. The expression profile of genes important in OPSCC also differed according to HPV-positivity for Ki67, CCND1, MET and PTEN/PIK3CA, but remained unchanged for EGFR, CDKN2A and p53.ConclusionInhibition of EZH2 has anti-tumorigenic effects on OPSCC cells in culture that is more pronounced in HPV-positive cell lines. EZH2 is a promising epigenetic target for the treatment of OPSCC.

on behalf of the PREDICT/Sunnybrook ICH-CTA study group Background and Purpose-Reliable quantification of both intracerebral hemorrhage and intraventricular hemorrhage (IVH) volume is important for hemostatic trials. We evaluated the reliability of computer-assisted planimetric volume measurements of IVH. Methods-Computer-assisted planimetry was used to quantify IVH volume. Five raters measured IVH volumes, total (intracerebral hemorrhageϩIVH) volumes, and Graeb scores from 20 randomly selected computed tomography scans twice. Estimates of interrater and intrarater reliability were calculated and expressed as an intrarater correlation coefficient and an absolute minimum detectable difference. Results-Planimetric IVH volume analysis had excellent intra-and interrater agreement (intrarater correlation coefficient, 0.96 and 0.92, respectively), which was superior to the Graeb score (intrarater correlation coefficient, 0.88 and 0.83). Minimum detectable differences for intra-and interrater volumes were 12.1 mL and 17.3 mL, and were dependent on the total size of the hematoma; hematomas smaller than the median 43.8 mL had lower minimum detectable differences, whereas those larger than the median had higher minimum detectable differences. Planimetric total hemorrhage volume analysis had the best intra-and interrater agreement (intrarater correlation coefficient, 0.99 and 0.97, respectively). Key Words: intracerebral hemorrhage Ⅲ intraventricular hemorrhage Ⅲ planimetry H ematoma volume and intraventricular hemorrhage (IVH) are independent predictors of outcome following intracerebral hemorrhage (ICH). 1-2 Early ventricular rupture and subsequent autodecompression of parenchymal hematoma is common in ICH. 3 Ventricular decompression of ICH results in IVH expansion, which is also associated with poor outcome. 2 Given that hematoma expansion is a common surrogate outcome for ICH studies, 4 easy and accurate measurement of IVH and volume dynamics following ventricular rupture is relevant to hemostatic trials. In this study, we sought to evaluate the reliability of computer-assisted planimetric measurements for quantifying IVH volumes. Conclusions-Computer-assisted MethodsThe computer-assisted volume measurement software Quantomo (Cybertrial) 5 was used to quantify IVH volumes. Quantomo provides an interface that enables raters to guide segmentation algorithms with manual planimetric intervention to quantify volumes on computed tomography (CT) and magnetic resonance scans. Raters measured ICH and IVH volumes by selecting a hematoma and adjusting intensity thresholds, adding or removing regions to the computerselected region at their discretion, and manually drawing boundaries to separate IVH from ICH. CT scans of patients with both ICH and IVH were blindly and randomly selected from the ongoing PREDICT study. 6 Five raters (2 neurologists, 1 radiologist, 1 neuroradiologist, and 1 radiology trainee) measured IVH volumes, total (ICHϩIVH) volumes, and Graeb scores from 20 randomly selected CT scans twice, presented in a blind...